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GENERAL REQUISITION OPEN LATE Monday to Friday 8am5pm OB & GUN Exams available Tuesdays & Thursdays 58pm (Last exam at 7:30pm) Glenwood Radiology Unit 107, 16028 100 A Avenue Edmonton, Alberta T5P
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How to fill out glenwood radiology requisition rorm

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How to fill out Glenwood Radiology Requisition Form
01
Gather all necessary information: Before filling out the form, ensure you have all the required information, such as patient details, referring physician's information, and specific tests or exams requested.
02
Start with patient information: Begin by entering the patient's full name, date of birth, gender, and contact information. Make sure to double-check the accuracy of this information to avoid any mix-ups.
03
Provide referring physician details: In the designated section, fill in the referring physician's name, address, telephone number, and any other required information. This helps ensure the results are sent to the correct healthcare provider.
04
Specify the tests or exams required: Indicate the specific tests or exams needed by checking the appropriate boxes or writing them down precisely. If there are any additional instructions or special considerations, make sure to mention them in the provided space.
05
Include relevant medical history: If there are any relevant medical conditions or previous tests related to the requested imaging, include this information in the designated section. It can provide context for the radiologist and aid in accurate interpretation.
06
Complete insurance information: Fill out the insurance details of the patient, including the policy number, group number, and any necessary authorizations or pre-certifications. It is crucial to provide accurate information to avoid any payment issues or delays.
07
Review and sign the form: Carefully go through the entire form to ensure all fields are properly filled in. If any sections are left unanswered, it may lead to processing delays. Finally, sign and date the form, indicating your consent and agreement to the terms.

Who needs Glenwood Radiology Requisition Form?

01
Patients requiring diagnostic imaging: Individuals who require specific diagnostic imaging tests, such as X-rays, MRIs, CT scans, or ultrasounds, would need to fill out the Glenwood Radiology Requisition Form. This form acts as a request for the imaging services and provides essential details for the radiologist.
02
Referring physicians or healthcare providers: Glenwood Radiology Requisition Form is required to be filled out by referring physicians or healthcare providers who want their patients to undergo specific diagnostic imaging tests. By completing this form, they provide necessary instructions and medical context to guide the radiologist in performing accurate interpretations.
03
Radiology facilities or departments: The Glenwood Radiology Requisition Form is also essential for radiology facilities or departments where the diagnostic imaging services are offered. It serves as a documentation tool, ensuring that requests from referring physicians or patients are received accurately and that the appropriate tests are scheduled and carried out.

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Glenwood radiology requisition form is a form used to request radiology services at Glenwood Medical Center.
Medical practitioners, referring physicians, or authorized healthcare providers are required to file the Glenwood radiology requisition form.
To fill out the Glenwood radiology requisition form, provide patient information, requested radiology services, reason for the request, and any relevant medical history.
The purpose of the Glenwood radiology requisition form is to authorize and request specific radiology services for a patient.
The Glenwood radiology requisition form must include patient demographics, referring provider information, medical history, requested radiology services, and reason for the request.
The deadline to file Glenwood radiology requisition form in 2023 is December 31st.
The penalty for the late filing of Glenwood radiology requisition form may result in delays in patient care or processing of the radiology request.
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